With funding from the National Institute of Nursing Research (Distribution of the Costs of Antimicrobial Resistant Infections, R01 NR010822), we have developed a database of >319,000 patient discharges from four urban (Manhattan) hospitals for the years 2006-8. This database has been used to answer a variety of clinical questions regarding healthcare-associated infections (HAI), but to continue to be useful and relevant; we have expanded and integrated the database as a targeted research data registry into the Clinical Data Warehouse of a large health care system. The data will continue to be updated and sustained so that trends over years can be tracked. Specific aims of this competitive renewal are to conduct three comparative effectiveness research (CER) studies on data from 2006-2012 to: (1) evaluate the effectiveness of adherence to transmission-based isolation precautions for preventing the spread of infections in acute care settings using transmission visualization techniques; (2) examine the impact of nursing organizational factors (e.g., staffing, skill mix, turnover) on rates and types of HAI among hospitalized patients; and (3 compare the effectiveness of universal contact precautions with standard practice in intensive care units (ICUs) to reduce rates of acquisition and infection caused by multidrug-resistant organisms (MDROs) and Clostridium difficile. In addition, as part of our Data Sharing Plan we propose to develop and/or adopt the following policies and procedures: data contributor and user agreements and data stewardship policies (right of first use, institutional and data confidentiality and protection, quality of the research, monitoring and integrity of data management) which will contribute to the burgeoning science of data governance. We will then make the registry more widely available to researchers for other CER project to assess practices to reduce HAI.